On arrival in Honolulu, the lepers are kept in a receiving station under observation and treatment. During my service they were examined by a board of three Honolulu physicians, and could not be sent to Molokai unless all three concurred in the diagnosis, nor could they be sent back home unless all three agreed they were non-leprous. If there was a disagreement they were kept in the receiving station until their cases became distinct pro or con.

This was the rule during my service. At the present time all suspects at the receiving station are examined by a bacteriologist microscopically, and no person is sent to Molokai in whom the bacilli of leprosy has not been demonstrated.

The common supposition is that Molokai is the leper island and the leper settlement. Such is not the case.

Lay a yeast cake on the table, slide a copper cent under it half the diameter of the cent, and let the other half protrude. The yeast cake and cent will represent the Island of Molokai and the visible portion of the cent will represent the leper settlement,-a flat plain on the windward side of the island, fertile in grass but nearly devoid of trees, cut off from the rest of the island by a precipice impassable except by one trail. This plain contains about eight square miles of land, two villages and five hundred and twenty buildings. This combination affords a prison and a refuge almost ideal in character. Here have been imprisoned since 1866, nearly six thousand lepers. The highest number at any one time was twelve hundred and thirteen in 1890. Since then, in spite of vastly improved methods of search and greatly increased thoroughness of apprehension, the number has dwindled to 874 on December 31st, 1902.

This must not be taken as meaning that the disease is necessarily on the decrease, as the population has decreased pari passu during the same period.

It has been prophesied that leprosy in Hawaii would become extinct. This is quite possible, and if it does it will be because dead Hawaiians are not leprous.

The governmental care of lepers in Hawaii, in and out of Molokai is scientific, generous, and humane.

Of the 874 lepers confined on December 31st, 1902, 794 were Hawaiians, thirty-nine Chinese, thirteen Portuguese, seven Germans, five Japanese, four Americans.

Of these 533 were male and 337 female. This proportion of about two to one between the sexes holds good all over the world.

On Molokai they enjoy liberal rations, comfortable homes, congenial occupations (i. e., rest and venery), a water supply abundant and pure, a climate the best in the world. Hospital facilities are offered far in excess of what the patients will utilize; medical attendance and supplies are on a liberal basis. Franciscan sisters and Trappist brothers attend to nursing and dressing with a zeal and loyalty that is touching. Church facilities are more than ample. Protestant and Catholic pastors are active and faithful, and the labors of martyred Father Damien are well perpetuated.

In 1895, a great advance was made by condemning and buying up the Kuleanas of Kamaainas, i. e., the homesteads of former residents who had held on to their property and homes, after the district had been used for leper purposes. It seems strange that this condition had been allowed to go on for thirty years. The cost of supporting the lepers had been about $130 per capita per an

num.

Treatment: This is not a thesis on leprosy, and not a place for a discussion of its therapy. Leprosy in Hawaii does not add to the world's knowledge of treatment except in a negative way.

Like all other incurable diseases, this affords an endless number of sure cures which have been pressed upon the government by ardent supporters, and most of

which have been used. Medicines from India and doctors from Japan have been given every facility, and have all shown their futility.

Hot baths, gurjun oil, chaulmoogra oil, ichthyol, chlorate of potash, chrysarobin, corrosive sublimate, pyrogallic and salicylic acids, have all proved of value; otherwise the treatment is symptomatic and hygienic.

Except to eliminate syphilitic factors, an important point in many cases, iodide of potash is valueless.

It has been found that among the very earliest manifestations, both clinically and bacteriologically, is a leprous rhinitis, with later a profuse discharge. Local treatment directed to the disinfection of the upper air passages is theoretically and actually of the greatest value in subduing the local trouble, retarding auto-infection and protecting the neighborhood from contamination.

Why should this garden spot, this "Paradise of the Pacific become the seat of such a disease where it became, in the language of the official report of 1886, "more virulent than elsewhere on the globe?" To answer this I will revert to Dr. Sajous' definition and his requirements of a "vital adynamia, inherited or acquired."

As instances of conditions which may produce this "vital adynamia," Sajous enumerated:

"Insufficient food, unwholesome food, excessive use of salt, a fish diet, exposure to cold and damp, alcoholism, malaria, overwork, syphilis, tuberculosis."

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In all of these ten items, with the exception of overwork" and, perhaps, "tuberculosis," is the Hawaiian exceptionally well grounded as a candidate. If these are the preliminary requirements for a fertile soil:when the seed is implanted, why should not the Hawaiian race accept the infection greedily and be decimated thereby?

These same factors accompanied with, and largely

caused by, foreign contamination and an artificial and unadaptable civilization, had already before the prevalence of leprosy killed off ninety per cent. of the sturdy

race.

What chance had the remaining ten per cent. with these deadly predisposing factors still active, against this new assault by the most loathsome and hopeless disease known?

Civilization and syphilization have gone hand-in-hand. Benevolent assimilation has done its great work,— cane grows in profusion over the lands which the natives once owned. The white man is making great fortunes, the Chinaman is doing all the work, Old Glory is floating at the masthead.

The few natives who are left are all Christians and those who are lepers and those who are not, all have their bibles and can read them in the English language. They can send a former prince as delegate to Congress, can have plenty of poi to eat without any labor; plenty of gin to drink with a little labor; plenty of Calvanistic preaching or Catholic mass,-why shouldn't they be happy? and the best of it is-they are!

THE FINSEN LIGHT, X-RAYS, AND HIGH-FRE

QUENCY ELECTRICAL CURRENTS IN

CERTAIN DISEASES OF THE SKIN.

L. DUNCAN BULKLEY, A.M.,M.D.

The subjects of photo-therapy and the influence of various electrical currents in certain diseases of the skin are so large and have been so abundantly elaborated during the past few years, that it would be quite impossible, as well as unnecessary, to make any full presentation of them on this occasion. But they have been of such intense practical interest to me that the brief statement of personal experience in regard to them may not be without interest to others.

At the outset I may say that it is difficult not to write too enthusiastically in regard to some features which will be mentioned presently. Some of the results ob tained, and some which have been credibly reported on all sides, with photographic representations, as well as those shown at medical societies, are so remarkable and satisfactory in certain cases, that the tendency is to form a hasty judgment.

It must be acknowledged, however, even by the most conservative, that the measures which are to to be discussed have passed the experimental stage, and that there are good grounds for believing that they are, per haps, the most important therapeutic agents which have been added to our armamentarium for a very long time. I use the words "added to our armamentarium" advis edly, for it is a mistake to suppose that we are always to expect such results as are often reported, in every case, or that these measures should be employed hastily or carelessly in every instance of the affections men